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The increasing public awareness of postoperative cognitive problems has, in part, led to the ASA Brain Health Initiative. This multi-pronged initiative will include research into definitions of risk factors for and best practices to avoid these disorders. We would like to take this opportunity to tell ASA Monitor readers about activities and ongoing discussions in this area.

First, a challenge facing cognitive decline research has been the lack of uniformity or agreement over measurements and definitions.1 Thus, an international nomenclature group is working on consensus definitions for what has become known as postoperative cognitive decline (POCD). This work is necessary because different research groups have used different criteria to define POCD, and often in different cognitive domains (executive function, memory, etc.).2 These divergent definitions have made it difficult to compare results across different studies. Further, just like any other human physiologic trait, human cognitive performance is a continuously distributed trait. Thus, POCD is probably best conceptualized as the tail end of the continuous distribution of cognitive change from before to after anesthesia and surgery,1 rather than as a dichotomous trait. Moreover, research criteria for POCD rarely include the subjective component – a component that is absolutely required in the neurodegeneration field to diagnose mild cognitive impairment (MCI) or dementia. Nonetheless, having specific testing thresholds for defining POCD would be extremely helpful for comparing results across research studies and, when ultimately coupled with subjective complaints, to recognize POCD as a real clinical syndrome. These measures would allow inclusion as a diagnosis in the DSM (Diagnostic and Statistical Manual of Mental Disorders) along with related disorders such as delirium, and a diagnosis code in the ICD-10. And to make these diagnoses consistent with the existing cognitive impairment field, a new nomenclature to replace POCD is being considered, which will be described at this year’s International Anesthesia Research Society meeting.